肝硬変ネットワーク 米国における肝硬変に対するロスバスタチンの有効性と安全性 (LCN RESCU)
肝硬変ネットワーク (LCN) 米国における肝硬変に対するロスバスタチンの有効性と安全性 (RESCU): 二重盲検無作為化プラセボ対照第 2 相試験
This is a double-blind, phase 2 study to evaluate safety and efficacy of rosuvastatin in comparison to placebo after 2 years in patients with compensated cirrhosis.
調査の概要
状態
状態
条件
条件
介入・治療
介入・治療
詳細な説明
This study is a randomized, double-blind, placebo-controlled Phase 2 clinical trial, of 20mg of rosuvastatin by mouth, once daily. Participants will be randomized (1:1) to either once daily placebo or once daily rosuvastatin.
Patients meeting all eligibility criteria will be assigned to a randomization arm prior to initiation of a 4-week lead-in phase of the study. All participants will undergo a 4-week, open-label active run-in phase to evaluate initial safety and adherence to rosuvastatin. During this active run-phase, all participants will receive target dose rosuvastatin-- 20 mg daily. After the active run-in phase, all participants will continue with their pre-assigned randomization (1:1) treatment of rosuvastatin 20 mg daily or matching placebo.
The total duration of the study will be 96 weeks in the assigned treatment arm plus the 4-week lead-in period. The primary outcome will be the mean change in liver stiffness from the baseline measurement to the end of study liver stiffness, as measured by ultrasound-based vibration-controlled transient elastography (VCTE).
There are 10 participating clinical centers, and we anticipate a total of 260 patients will be recruited for the initial lead-in as we estimate 20% of participants may dropout after the lead-in (260 x 0.8 = 208 for randomization into the study drug treatment phase).
研究の種類
研究の種類
入学 (推定)
入学
段階
段階
- フェーズ2
連絡先と場所
研究連絡先
研究連絡先
- 名前:Crystal Santillanes, MS
- 電話番号:312-503-5536
- メール:lcn@northwestern.edu
研究連絡先のバックアップ
- 名前:Mary Beth Tull, MBA, CCRP
- 電話番号:312-503-4746
- メール:mary.tull@northwestern.edu
研究場所
-
-
California
-
La Jolla、California、アメリカ、92035
- 募集
- University of California San Diego NAFLD Research Center
-
コンタクト:
- Rohit Loomba
- メール:roloomba@health.ucsd.edu
-
Los Angeles、California、アメリカ、90033
- 募集
- Keck Medical Center of USC
-
コンタクト:
- Norah Terrault
- メール:norah.terrault@med.usc.edu
-
Los Angeles、California、アメリカ、90033
- 募集
- LAC + USC Medical Center
-
コンタクト:
- Norah Terrault
- メール:norah.terrault@med.usc.edu
-
San Francisco、California、アメリカ、94143
- 募集
- UCSF Medical Center
-
コンタクト:
- Bilal Hameed
- メール:bilal.hameed@ucsf.edu
-
San Francisco、California、アメリカ、94110
- 募集
- UCSF/Zuckerberg San Francisco General Hospital and Trauma Center
-
コンタクト:
- Mandana Khalili
- メール:Mandana.Khalili@ucsf.edu
-
-
Florida
-
Miami、Florida、アメリカ、33122
- 募集
- University of Miami Health System
-
コンタクト:
- David Goldberg
- メール:dsgoldberg@med.miami.edu
-
-
Michigan
-
Ann Arbor、Michigan、アメリカ、48109
- 募集
- University of Michigan
-
コンタクト:
- Elliot Tapper
- メール:etapper@med.umich.edu
-
-
Minnesota
-
Rochester、Minnesota、アメリカ、55901
- 募集
- Mayo Clinic
-
コンタクト:
- Doug A. Simonetto, MD
- 電話番号:(507) 284-2511
- メール:simonetto.douglas@mayo.edu
-
-
New York
-
New York、New York、アメリカ、10021
- 募集
- New York Presbyterian/Weill Cornell
-
コンタクト:
- Robert Brown
- メール:rsb2005@med.cornell.edu
-
New York、New York、アメリカ、10031
- 募集
- Columbia University Iriving School of Medicine
-
コンタクト:
- Elizabeth Verna
- メール:ev77@cumc.columbia.edu
-
-
North Carolina
-
Durham、North Carolina、アメリカ、27710
- 募集
- Duke Liver Center
-
コンタクト:
- Cynthia Ann Moylan, MD, MHS, MS
- 電話番号:919-681-4044
- メール:cynthia.moylan@duke.edu
-
コンタクト:
- Mariko Kopping
- メール:mariko.kopping@duke.edu
-
-
Ohio
-
Cleveland、Ohio、アメリカ、44192
- 募集
- Cleveland Clinic
-
コンタクト:
- Srinivasan Dasarathy
- メール:DASARAS@ccf.org
-
-
Virginia
-
Richmond、Virginia、アメリカ、23298
- 募集
- Virginia Commonwealth University
-
コンタクト:
- Arun Sanyal
- メール:arun.sanyal@vcuhealth.org
-
-
参加基準
適格基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria
-
Age 18-75 years
-
Cirrhosis due to NAFLD, ALD, or chronic viral hepatitis (treated HBV or HCV)
-
Clinical diagnosis of cirrhosis as defined by investigator confirmation and the following:
a. At least one liver biopsy within 5 years prior to consent showing either: Metavir stage 4 fibrosis; Ishak Stage 5-6 fibrosis, OR b. At least 2 of the following: i. Evidence on imaging: Nodular liver with either splenomegaly or recanalized umbilical vein within the past 48 weeks ii. Liver stiffness: VCTE within 48 weeks prior to consent or during Screening ≥15.0 kPa or MRE within 48 weeks prior to consent or during Screening ≥5 kPa iii. Evidence of varices demonstrated on imaging or endoscopy within 3 years prior to consent or during Screening iv. Either: FIB-4>2.67 or platelets <150/mL within 6 months prior to consent or during Screening
-
Two measures of VCTE: one at screening and one at the open-label dispense study visit, meeting the following criteria:
- The first measure must be ≥ 15.0 kPa.
- The two measures must be at least 2 hours apart and no more than 60 days apart from one another.
- The mean of two measurements must be ≥ 15.0 kPa.
- Additionally, both screening and open-label dispense liver stiffness measures must be ≤50 kPa
-
Compensated defined by:
- Absence of ascites/hydrothorax, hepatic encephalopathy or variceal bleeding currently or in the last 48 weeks, as determined clinically by investigator.
- If prior history of decompensation, must be without current symptoms of decompensation and no longer requiring treatment of complications for the last 48 weeks, including the use of diuretics for the treatment of ascites, and/or rifaximin or lactulose for the treatment of hepatic encephalopathy. Use of non-selective beta blockers will be allowed.
- Child-Pugh score <8
-
Provision of written informed consent. Exclusion Criteria
-
Currently on a statin or any statin exposure within 24 weeks prior to consent.
-
Known indication for statin therapy, defined as:
- Prior peripheral vascular, cardiovascular or cerebrovascular event for which statins are indicated for secondary prevention, OR
- Documented familial hypercholesterolemia, heterozygous familial hypercholesterolemia, OR
- Fasting LDL-C ≥ 190 mg/dL
-
Myocardial infarction, Unstable angina, transient ischemic events, or stroke within 24 weeks of screening.
-
Alcohol Use Disorder Identification Test (AUDIT) total score of ≥8 at screening.
-
Patients with limitations in attending study visits.
-
Prisoners.
-
Known prior or current hepatocellular carcinoma (HCC) or cholangiocarcinoma.
-
Known transjugular intrahepatic portosystemic shunt (TIPS), balloon retrograde transvenous obliteration (BRTO) or porto-systemic shunt surgery regardless of time of occurrence.
-
Current (in past 24 weeks prior to consenting) use of medications known to cause hepatic fibrogenesis or confound endpoint assessment, defined as:
- amiodarone
- methotrexate
- warfarin
-
Current (in past 24 weeks prior to consenting) use of medications which may increase risk for rosuvastatin-related myositis or DILI, defined as:
-
fenofibrate
-
erythromycin
-
gemfibrozil
-
niacin (500 mg or more)
-
HIV protease inhibitors (darunivar, indinavir, nelfinavir, amprenavir)
-
colchicine
-
cyclosporin
-
Additional medications that will be excluded:
atazanavir/ritonavir capmatinib darolutamide dasabuvir/ombitasvir/paritaprevir/ritonavir ledipasvir/sofosbuvir elbasvir/grazoprevir erythromycin lopinavir/ritonavir regorafenib ritonavir, in any combination simeprevir sofbuvir/velpatasvir/voxilaprevir sofosbuvir/velpatasvir tafamidis tamoxifen teriflunomide
*If exposure was for 7 or less days for one of these medications can consider enrollment after 28 days from final dose.
-
-
Presence of portal or hepatic vein thrombosis
-
Diagnosis of untreated hypothyroidism or on unstable treatment regimen for hypothyroidism
-
Receiving an elemental diet or parenteral nutrition
-
Chronic pancreatitis or pancreatic insufficiency
-
Etiology of cirrhosis other than ALD, NAFLD, or viral hepatitis (excluded diagnoses include cryptogenic immune-mediated such as AIH, PSC and PBC, cardiac cirrhosis or Fontan-associated liver disease, A1AT, Wilson's disease, etc.)
-
Conditions which may confound study outcome:
a. Unstable or active inflammatory bowel disease b. Active infection c. Any malignant disease (other than squamous or basal cell carcinoma of the skin) within previous 3 years d. Prior solid organ or hematopoietic cell transplant e. Bariatric surgery in the last 24 weeks prior to consent or planned bariatric surgery within the next 96 weeks f. Current liver-unrelated end-stage organ failures such as end-stage renal disease on dialysis, stage 3-4 congestive heart failure (CHF), current chronic obstructive pulmonary disease (COPD) on home oxygen.
-
Known current medical or psychiatric conditions which, in the opinion of the investigator, would make the participant unsuitable for the study for safety reasons or interfere with or prevent adherence to the protocol.
-
The following laboratory abnormalities within 90 days of screening:
a. Hemoglobin <10 g/dL b. Albumin <3.0 g/dL c. Prolonged international normalized ratio (INR) >1.5 d. Total bilirubin ≥ 2.0 mg/dl (unless due to Gilbert's syndrome or hemolysis as denoted by normal direct bilirubin fraction) e. Direct bilirubin ≥ 0.9 f. Uncontrolled diabetes (HbA1c ≥ 9.5%) within past 90 days.
-
Kidney function abnormalities including:
- Dialysis
- Baseline eGFR < 30 cc/min with CKD-Epi equation
- Known nephrotic proteinuria, defined as 3g or greater of protein in 24-hour urine collection
-
Recent (within 48 weeks) or present hepatic decompensation with ascites/hydrothorax, hepatic encephalopathy or variceal bleeding
-
Untreated chronic hepatitis B or C infection
- HCV eligible for enrollment if HCV RNA negative at baseline or documentation of prior SVR12
- HBV eligible if an HBV DNA <100 IU/mL within the last 48 weeks and on treatment
-
Serum aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≥ 200 U/L within the past 24 weeks or alkaline phosphatase (ALP) ≥ 300.
-
Documented history of intolerance to statins
-
Serious comorbid medical disease which in the investigator's opinion renders a life-expectancy less than 96 weeks
-
Active illicit substance use (other than THC), including inhaled or injected drugs, in the 24 weeks prior to screening
-
Pregnancy, planned pregnancy or breastfeeding
-
Current participation in active medication treatment trials (within 24 weeks prior to randomization) or planned participation in active medication treatment trials simultaneous to participation in present trial.
-
Significant existing muscle pain or tenderness or prior history of myasthenia gravis as determined by a site physician.
-
Failure or inability to provide informed consent.
-
East Asian Descent within one degree of relatedness (e.g., if the participant's parents are of East Asian descent)
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:4倍
アーム数
武器と介入
参加者グループ / アーム参加者グループ / アーム |
介入・治療介入・治療 |
|---|---|
|
実験的:Active
Open-label lead-in period of 4 weeks on 20 mg rosuvastatin by mouth once daily, followed by a period of 96 weeks rosuvastatin 20 mg daily. |
Patients meeting all eligibility criteria will be assigned to a randomization arm prior to initiation of a 4-week lead-in phase of the study. All participants will undergo a 4-week, open-label active run-in phase to evaluate initial safety and adherence to rosuvastatin. During this active run-phase, all participants will receive target dose rosuvastatin-- 20 mg daily . After the active run-in phase, all participants will continue with their pre-assigned randomization (1:1) treatment of rosuvastatin 20 mg daily or matching placebo.
他の名前:
|
|
プラセボコンパレーター:Placebo
Open-label lead-in period of 4 weeks on 20 mg rosuvastatin by mouth once daily, followed by a period of 96 weeks placebo. |
Patients meeting all eligibility criteria will be assigned to a randomization arm prior to initiation of a 4-week lead-in phase of the study. All participants will undergo a 4-week, open-label active run-in phase to evaluate initial safety and adherence to rosuvastatin. During this active run-phase, all participants will receive target dose rosuvastatin-- 20 mg daily . After the active run-in phase, all participants will continue with their pre-assigned randomization (1:1) treatment of rosuvastatin 20 mg daily or matching placebo.
他の名前:
|
この研究は何を測定していますか?
主要な結果の測定
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Mean change in liver stiffness
時間枠:96 weeks
|
Mean change in liver stiffness as measured in kilopascal with Vibration-Controlled Transient Elastography between study entry and week 96. Range: 2 to 75 kilopascal. Higher stiffness indicates increased disease progression |
96 weeks
|
二次結果の測定
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Time to disease progression
時間枠:96 weeks
|
Time to disease progression defined as time to development of decompensation event (ascites, hepatic encephalopathy, variceal bleed) or hepatocellular carcinoma. Analyzed as time-to-event; binary if low counts. |
96 weeks
|
|
All-cause mortality
時間枠:96 weeks
|
All-cause mortality: time-to-event, binary if low counts |
96 weeks
|
|
Time to development of ascites
時間枠:96 weeks
|
Ascites: time-to-event, binary if low counts |
96 weeks
|
|
Time to development of overt hepatic encephalopathy
時間枠:96 weeks
|
Time to development of overt hepatic encephalopathy: time-to-event, binary if low counts |
96 weeks
|
|
Time to development of variceal bleed
時間枠:96 weeks
|
Variceal bleed: time-to-event, binary if low counts |
96 weeks
|
|
Time to development of hepatocellular carcinoma
時間枠:96 weeks
|
Hepatocellular carcinoma: time-to-event, binary if low counts |
96 weeks
|
|
Change in spleen stiffness as measured by Vibration-Controlled Transient Elastography (VCTE)
時間枠:96 weeks
|
Units: kilopascal; Range: 5 to 100 kilopascal; higher stiffness indicates increased disease progression |
96 weeks
|
|
Change in Child-Turcotte-Pugh score
時間枠:96 weeks
|
Ordinal score from 5 to 15; higher score indicates further disease progression |
96 weeks
|
|
Change in Model for End Stage Liver Disease - Sodium (MELD-Na)
時間枠:96 weeks
|
Unitless; Range: 6-40; higher score indicates further disease progression |
96 weeks
|
|
Change in liver stiffness via Magnetic Resonance Elastography
時間枠:96 weeks
|
Units: kilopascal; Range: 0 to 20; higher stiffness indicates increased disease progression |
96 weeks
|
|
Change in Enhanced Liver Fibrosis test
時間枠:96 weeks
|
Unitless; Range: 5 to 11; Higher score is worse |
96 weeks
|
|
Change in Fibrosis-4
時間枠:96 weeks
|
Unitless; Range: 0 to 10; higher score indicates more stiffness |
96 weeks
|
|
Change in patient-reported quality of life scores
時間枠:96 weeks
|
Patient Reported Outcomes Measurement Information System (29-item version) Global Health T-Score: Population centered at 50 points, standard deviation of 10 (higher score signifies "better" health) |
96 weeks
|
|
Rate of adverse events
時間枠:96 weeks
|
Count |
96 weeks
|
|
Rate of serious adverse events
時間枠:96 weeks
|
Count |
96 weeks
|
|
Rate of adverse events of special interest
時間枠:96 weeks
|
Rate of adverse events of special interest (myopathy, drug-induced liver injury, cardiovascular events, cancer other than hepatocellular carcinoma, new onset diabetes as separate outcomes): Count |
96 weeks
|
|
Time to cardiovascular events
時間枠:96 weeks
|
Cardiovascular events: time-to-event, binary if low counts |
96 weeks
|
|
Time to new onset diabetes
時間枠:96 weeks
|
New onset diabetes: time-to-event, binary if low counts |
96 weeks
|
協力者と研究者
スポンサー
スポンサー
協力者
協力者
捜査官
捜査官
- 主任研究者:Abigail Smith, PhD、Northwestern University
出版物と役立つリンク
研究記録日
主要日程の研究
研究開始 (実際)
研究開始
一次修了 (推定)
一次修了
研究の完了 (推定)
研究の完了
試験登録日
最初に提出
最初に提出
QC基準を満たした最初の提出物
QC基準を満たした最初の提出物
最初の投稿 (実際)
最初の投稿
学習記録の更新
投稿された最後の更新 (実際)
投稿された最後の更新
QC基準を満たした最後の更新が送信されました
QC基準を満たした最後の更新が送信されました
最終確認日
最終確認日
詳しくは
本研究に関する用語
キーワード
追加の関連 MeSH 用語
その他の研究ID番号
その他の研究ID番号
- Pro00070580
- 5U24DK130164-04 (米国 NIH グラント/契約)
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
IPD プランの説明
Dataset with National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Repository.
IPD 共有サポート情報タイプ
- STUDY_PROTOCOL
- ICF
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
米国FDA規制機器製品の研究
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。